Bariatric surgery in obese older people: useful or not?

Our publication on the potential benefits of bariatric surgery in obese older people, work that followed on from our MID-Frail and Frailomic studies, was published in the journal Cardiovascular Endocrinology [1]. The aim of the Niche team was to determine whether older (≥65 years) obese individuals would benefit from bariatric surgery, taking into account the high prevalence of multiple comorbidities and frailty in this population [2,3].

This was a literature-based investigation in which a PubMed search was conducted to identify studies reporting bariatric surgery outcomes in older adults between 1980 and August 2014. This approach reflects the limited prospective trial data available for elderly populations, who have historically been underrepresented in bariatric surgery studies [4]. Of the retrieved citations, a small subset contained usable outcome data, consistent with previous observations that most bariatric surgery evidence in older patients is derived from retrospective analyses and registry studies [5].

Published data were available for efficacy outcomes in several hundred older patients. These data demonstrated substantial postoperative improvements in obesity-related comorbidities, including type 2 diabetes mellitus, hypertension, and obstructive sleep apnoea, findings that are consistent with reports from both elderly-specific cohorts and mixed-age populations [6–8]. Laparoscopic adjustable gastric banding was the most frequently reported procedure in older patients, reflecting historical preferences for less invasive techniques with perceived lower perioperative risk [9]. Reports of other procedures, such as gastric bypass and sleeve gastrectomy, suggested greater weight loss but were based on smaller patient numbers, limiting the robustness of conclusions [10,11].

Data from large national and international bariatric surgery registries have shown that older age is associated with increased perioperative morbidity and mortality compared with younger patients, particularly following gastric bypass procedures [12–14]. Older patients also experience longer hospital stays and worse outcomes in the presence of significant cardiac, pulmonary, or renal comorbidities, highlighting the importance of careful patient selection and risk stratification [13–15].

Overall, the study concludes that while bariatric surgery in older people can be effective in reducing obesity-related complications, it is associated with higher complication rates than those observed in younger cohorts. This conclusion aligns with previous systematic reviews and registry analyses, which emphasize that the available evidence in elderly patients is largely retrospective, focused on adjustable gastric banding, and limited by small sample sizes and short follow-up durations [5,9,12]. Additional prospective trials and long-term registry data—particularly for sleeve gastrectomy and gastric bypass—are required to better define the role of bariatric surgery in elderly populations and to clarify long-term clinical outcomes [10,11,14].

References

1. Reijntjes SJ, et al. Bariatric surgery in obese older people: useful or not? Cardiovasc Endocrinol. 2015;4:60–66.
2. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–M156.
3. Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement. Am J Clin Nutr. 2005;82(5):923–934.
4. Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135(3):326–351.
5. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627–1635.
6. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–1737.
7. Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25(2):358–363.
8. Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535–542.
9. Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–454.
10. Kehagias I, Karamanakos SN, Argentou M, Kalfarentzos F. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI <50 kg/m². Obes Surg. 2011;21(11):1650–1656.
11. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–475.
12. Livingston EH, Huerta S, Arthur D, Lee S, De Shields S. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236(5):576–582.
13. Nguyen NT, Silver M, Robinson M, et al. Result of a national audit of bariatric surgery performed at academic centers: a 2004 University HealthSystem Consortium Benchmarking Project. Arch Surg. 2006;141(5):445–449.
14. Mognol P, Chosidow D, Marmuse JP. Laparoscopic gastric bypass in patients older than 60 years. Obes Surg. 2004;14(5):628–634.
15. Sugerman HJ, DeMaria EJ, Kellum JM, et al. Effects of bariatric surgery in older patients. Ann Surg. 2004;240(2):243–247.